Provider Demographics
NPI:1093714107
Name:GABRIEL, DAVID ROY (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROY
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5234
Mailing Address - Country:US
Mailing Address - Phone:401-847-1040
Mailing Address - Fax:401-847-1049
Practice Address - Street 1:73 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5234
Practice Address - Country:US
Practice Address - Phone:401-847-1040
Practice Address - Fax:401-847-1049
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-01-09
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
RIODT 362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU400337379Medicare PIN